Expanding the Medical Record in Massachusetts

Some workers’ compensation cases are more medically complex and it may be necessary for the judge to expand the medical record to make a sound finding. In a recent case a Massachusetts employer (Snap Mart) appealed after an administrative judge awarded workers’ compensation benefits and the court denied its motion to settle and clarify the record. The employer argued the judge had abused her discretion by expanding the record because of medical complexity. It also argued that the issue of medical complexity should not be up to a judge’s discretion, but another standard. It agued that the judge’s decision as to the worker’s earning capacity was arbitrary and capricious.

The appellate court explained that the administrative judge had found the issues in this case medically complex. A worker can introduce additional medical evidence where medical issues are complex. This is an issue committed to the administrative judge’s discretion. Snap Mart had not objected at the lower level, which meant it could not appeal on this point. However, the appellate court found that even if the employer had properly objected, there was no abuse of discretion.

The court explained that the judge was entitled to adopt the doctor’s opinion that the medical condition was complex. The worker’s medical history showed he had suffered acute injury and also had a preexisting condition of posttraumatic arthritis and damage to his leg and knee as a result of being tortured in his native country before the workplace injury.

The employer argued that expert testimony was required to determine whether the medical issues were complex. The court explained that a finding of medical complexity did not turn on an expert medical opinion to that effect. Nothing in the statute suggested this was necessary.

The court also found the employer had waived its argument that the judge’s calculation of worker earning capacity was arbitrary for being based solely on worker’s post-injury actual earnings. But it found that even if the argument had been preserved, the argument would fail because the judge’s findings had covered a lot of other factors that negatively impacted post-injury earning ability. These included language constraints, age, education and physical limitations. These factors supported he judge’s decision that the worker’s actual wages reflected what he was capable of earning.

The employer had also filed a motion to settle and clarify the record. Its goal was to find that it had preserved an objection during the hearing. The judge denied the motion. At that point the employee could have made a request for a factual finding. However, the hearing transcript found that Snap Mart had the opportunity to object to the extra medical evidence and didn’t.

The employer’s attorney had submitted an affidavit that said the Trust Fund’s attorney had objected to the worker’s motion and the judge’s ruling. The court explained the single justice who ruled on the motion to clarify was no obliged to credit the employer’s attorney’s affidavit, when it wasn’t confirmed by the attorney that actually made the objection.

The appellate court also declined to change the standard by which an administrative judge could decide whether a medical issue was complex. The statute clearly left this up to an administrative law judge’s discretion.

If you are hurt at work, you may be entitled to workers’ compensation benefits. An experienced Massachusetts workers’ compensation attorney can evaluate whether you have a sound claim and fight to make sure that your employer and its insurer follow the rules or give you guidance if there is no insurance available. Contact us by calling 800-367-0871 or using our online contact form.